Lower limb ischaemia in primary antiphospholipid syndrome

Area of Science:

• Vascular Surgery
• Autoimmune Disorders
• Rheumatology

Background:

• Primary antiphospholipid syndrome (PAPS) is an autoimmune condition causing recurrent venous and arterial thrombosis.
• Lower limb ischemia presents a significant clinical challenge in patients with PAPS.

Purpose of the Study:

• To investigate the outcomes of vascular surgical procedures in patients with lower limb ischemia secondary to PAPS.
• To determine the risk factors for graft failure and identify optimal perioperative management strategies.

Main Methods:

• Retrospective case series of seven patients with PAPS and lower limb ischemia.
• Review of patient history, clinical presentation, diagnostic tests (including antiphospholipid antibody testing), angiographic findings, and treatment outcomes.
• Analysis of vascular surgical procedures, including percutaneous transluminal angioplasty and bypass grafting, and their associated complications.

Main Results:

• All seven patients experienced lower limb ischemia, with symptoms including claudication, rest pain, and gangrene.
• Angiography revealed arterial thrombosis in multiple segments (aorta, iliac, femoral, popliteal).
• Vascular surgery in four patients resulted in a high rate of early postoperative graft thrombosis (10 out of 11 procedures), with only one graft remaining patent when full heparinization was employed perioperatively.

Conclusions:

• PAPS patients with lower limb ischemia face a high risk of graft thrombosis following vascular interventions.
• Perioperative and long-term full anticoagulation is essential for improving graft patency in these high-risk patients.
• Vascular surgery should be approached with extreme caution and aggressive anticoagulation protocols in the setting of PAPS.